Aetna case management any info?

jlcole45 · Nov 25, 2007

Actually AETNA is a huge insurance company and they do employ nurses. I used to do case management - in house and I loved it.

This sort of work is more desk work, lots of phone calls talking to docs and patients (or their families), negotiating lengths of stays, assisting with discharge planning, etc.... it's not as hands on but there is a level of job satisfaction.

I have been thinking of returning to case management. Can you post the contact information? I would love to see if they need a representative in my neck of the woods.

Thanks and good luck.

dria · Nov 25, 2007

i work as a case manager for a large insurace company, but it isn't aetna. i do have a friend working cm for aetna, and from our discussions, i can say that the following is true for both of our positions:

jlcole is correct in saying that this is a desk job...you can expect to spend your day at your desk on the phone at the computer. however, what she is describing regarding length of stay, discharge planning is handled by the inpatient reivew teams, not case managers (in both of our cases)

we spend the bulk of our day on the phone with the members (or family.) generally, you assess their ability to manage their chronic health conditions, and their compliance with the prescribed treatment regimen. you attempt to help the member remove any obstacles that exist, whether they are knowledge deficits, financial issues, or access to care. as with any nursing position, you ensure client safety and screen for harmful drug interactions. you may also assist with affordability of medications, either through education of lower cost meds, or direction to community resources/paps. you ensure that the care given is in accordance with evidence based guidelines, and may speak with the physicians office if there is no obvious contraindication (at the end of the day, it is still up to the physicians judgement.) in many cases, you work with the physicians office to ensure the common goal of the best outcome for that individual. you assist the member with getting the care that they need, in the most cost-effective manner. you ensure that the members psychosocial needs are being met. you help the member understand their benefits (and in most cases, dont make benefit determinations.)

i'm sure there is more, but i think this gives you a general idea. i'm sure those that follow will have more to add....i think your experience makes you a great candidate for cm. i hope you can tell that i really enjoy working in cm. i derive a great deal of satisfaction from what i do, and know that i have truly made a difference in the lives of the people i work with. this is my niche. you (and anyone else who is interested) are welcome to pm me at anytime. i am more than happy to answer any questions you may have.

thanks for hanging in with me thru this long post, and good luck!

annmariern · Nov 25, 2007

Actually AETNA is a huge insurance company and they do employ nurses. I used to do case management - in house and I loved it.
This sort of work is more desk work, lots of phone calls talking to docs and patients (or their families), negotiating lengths of stays, assisting with discharge planning, etc.... it's not as hands on but there is a level of job satisfaction.
I have been thinking of returning to case management. Can you post the contact information? I would love to see if they need a representative in my neck of the woods.
Thanks and good luck.

https://aetna.recruitmax.com/ENG/candidates/default.cfm

Thank you both for your imput. As a bedside nurse for so long its a scary jump, but sounds like one well worth looking into, thanks again